Abstract Ref Number = APCP1122
Multi-drug Resistant Tuberculosis Presented as Meningoencephalitis TB in 3 Months-Old Infant-A Case Report of The Youngest Ever Diagnosed
Aulia Rahman,Tania Ryandini,Heda Melinda Nataprawira
Department of Child Health Universitas Padjadjaran Bandung
Background : Multi-drug Resistant Tuberculosis (MDR-TB) has been increasing in terms of incidence, especially in developing countries. Eventhough pediatric tuberculosis (TB) accounts for 15–20% of the global TB burden, MDR-TB is still poorly studied and reported in this population. In developing country like Indonesia,diagnosing and treating MDR-TB is still challenging.
Case Presentation Summary : A 3-months-old boy weighing 5.5 kg was referred to the emergency ward of Hasan Sadikin General Hospital, Bandung with shortness of breath, accompanied by slight fever and lethargy. The child was born from a mother who underwent meningitis TB therapy until her 3 months of pregnancy. Initial laboratory tests were within normal limit; HIV viral load was undetected. Cerebrospinal fluid was clear, with cell count of 11, PMN 27%, MN 73%, negative Pandy’s test, LDH of 26 u/L, protein of 52 mg/dl, glucose of 59 mg/dl and no bacteria found. Initial X-ray showed milliary TB pattern with secondary infection. Gastric aspirate specimen showed acid-fast bacilli and negative GeneXpert. Due to lack of improvement after antituberculosis therapy, GeneXpert from gastric aspirate was re-taken on the 20th day of hospitalization to confirm the suspicion of MDR-TB. The specimen was detected to be Rifampicin resistance Mycobacterium tuberculosis. Since sensoryneural hearing loss was found on the right ear. He was treated with levofloxacin, capreomycin, cycloserine, ethionamide, pyrazinamide, and ethambutol with improvement in the 6th week of treatment. Body weight during time of discharge was 6 kg.
Learning Points/Discussion : The diagnosis and treatment of MDR-TB in children are complex. Although obtaining specimen for bacterial confirmation from children is often difficult with drug-resistant TB more likely to be underdiagnosed, younger children have similar likelihood of harbouring drug-resistant strains than older children.
Keywords: multidrug resistant tuberculosis infant